Elder J S
Department of Urology, Rainbow Babies and Childrens Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio.
J Urol. 1992 Jul;148(1):117-9. doi: 10.1016/s0022-5347(17)36529-1.
There are numerous options for continent urinary reconstruction in children. If the appendix is available and the bladder capacity is satisfactory, a Mitrofanoff procedure may be performed using the appendix as a catheterizable tube implanted into the bladder. However, in many patients the bladder is absent or too small for this type of reconstruction. An alternative technique, termed appendicocolostomy, is to implant the appendix under the tenia of a detubularized patch of cecum or sigmoid colon, which becomes part of a continent neobladder or is attached to the bladder itself. This procedure has been used in 12 children and 1 adult undergoing continent reconstruction. Urological diseases included bladder exstrophy (10 patients) and a neuropathic bladder (3). Two patients underwent undiversion of a sigmoid conduit, while in 7 of the remaining patients the bladder was included in the reservoir. In 1 patient histological examination of the tip of the appendix revealed an incidental invasive carcinoid tumor necessitating appendectomy and revision of the reconstruction. Otherwise, no complications have occurred. Three adults were scheduled for this procedure but the appendix was diseased and an alternative form of diversion was necessary. Followup ranged from 2 months to 4 years. All patients are totally dry with a capacity of 300 to 750 cc (mean 475 cc). The appendicocolostomy is a superior form of conduit reconstruction that should be considered when the appendix is available during continent reconstruction. However, in adults the appendix may be fibrotic, precluding its use. Because most boys with exstrophy and a small bladder capacity requiring augmentation cystoplasty must perform intermittent catheterization, attachment of the appendix to the reservoir is an alternative that allows for easier and less painful intermittent catheterization than catheterization of the reconstructed epispadiac penis.
儿童可控性尿路重建有多种选择。如果阑尾可用且膀胱容量满意，可采用米氏手术，将阑尾作为可插管的管道植入膀胱。然而，许多患者的膀胱缺失或过小，无法进行此类重建。另一种技术称为阑尾结肠造口术，即将阑尾植入去管化的盲肠或乙状结肠带下方，后者成为可控性新膀胱的一部分或附着于膀胱本身。该手术已应用于12例儿童和1例接受可控性重建的成人。泌尿系统疾病包括膀胱外翻（10例患者）和神经源性膀胱（3例）。2例患者进行了乙状结肠导管的回肠改道术，其余7例患者的膀胱被纳入贮尿囊。1例患者阑尾尖端的组织学检查发现偶然的侵袭性类癌肿瘤，需要进行阑尾切除术并修改重建方案。除此之外，未发生并发症。3例成人原计划进行该手术，但阑尾病变，需要采用其他改道方式。随访时间为2个月至4年。所有患者均完全无尿失禁，贮尿囊容量为300至750毫升（平均475毫升）。阑尾结肠造口术是一种较好的管道重建方式，在可控性重建过程中阑尾可用时应予以考虑。然而，在成人中，阑尾可能纤维化，无法使用。由于大多数膀胱外翻且膀胱容量小需要膀胱扩大成形术的男孩必须进行间歇性导尿，将阑尾附着于贮尿囊是一种替代方法，与重建阴茎型尿道上裂的导尿相比，它能使间歇性导尿更容易且痛苦更小。
